Traumatic Right Coronary Artery Dissection as a Cause of Inferior Wall ST-Elevation Myocardial Infarction.

Vrinda Vyas,Tamas Szombathy,Madhuri Badrinath

doi:10.7759/cureus.6694

Vrinda Vyas, Tamas Szombathy + Show 1 more

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https://doi.org/10.7759/cureus.6694

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Journal: Cureus	Publication Date: Jan 18, 2020
Citations: 6	License type: cc-by

Affiliation: SUNY Upstate Medical University

Abstract

Blunt cardiac injury, causing coronary artery dissection in the absence of other forms of injury to the heart or lungs is a rare occurrence. Here we present a case of a 41-year-old male who presented with right coronary artery (RCA) dissection after blunt chest trauma. The patient initially presented with chest pain and was diagnosed with an inferior wall myocardial infarction (MI). He then developed a complete heart block and bedside echocardiogram showed right ventricular akinesis. Immediate coronary angiography showed RCA dissection, and TIMI 3 flow was established after the placement of four drug-eluting stents. Blunt trauma-induced RCA dissection is associated with high mortality which needs immediate treatment. Hence through this case report, we would like to stress the importance of having a high index of suspicion for this condition in patients with a blunt chest injury.

Highlights

Common causes of an inferior wall myocardial infarction (MI) include atherosclerotic disease secondary to hypertension and diabetes, coronary artery spasms and inflammatory systemic diseases
We present a case of a 41-year-old male who presented with right coronary artery (RCA) dissection after blunt chest trauma
Immediate coronary angiography showed RCA dissection, and TIMI 3 flow was established after the placement of four drug-eluting stents

Summary

Introduction

Common causes of an inferior wall myocardial infarction (MI) include atherosclerotic disease secondary to hypertension and diabetes, coronary artery spasms and inflammatory systemic diseases. Traumatic coronary artery dissection from blunt thoracic trauma, leading to an acute MI has a low incidence [1,2]. In patients who sustain a chest trauma and develop persistent chest pain without any signs of hemopericardium, haemothorax or pneumothorax, it is crucial to have a high index of suspicion for coronary artery trauma. The diagnosis may be especially difficult in the absence of an electrocardiogram (EKG) because chest pain following a blunt thoracic injury can be interpreted as being secondary to chest wall contusion, rib fractures, or it may be overlooked in the presence of other injuries. We present a case of a 41-year-old male who presented with a traumatic RCA dissection leading to inferior wall STelevation myocardial infarction (STEMI). The management of traumatic coronary artery dissection remains controversial and there is no established standard of care [1]

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